WANTED: One Million Nurses

In 1991, Jennifer Mosier quit her job as a hairdresser and
enrolled in nursing school. Later this year, the 37-year-old from
Cleveland, Ohio, plans to quit her job as an acute care nurse and
open up a beauty salon. Mosier says she turned to nursing 11 years
ago to follow a childhood dream of â€œtaking care of
people.â€? Today, fed up with what she calls unrealistic
nurse-to-patient workloads, she's ready to give up the eight years
and $20,000 of educational investment for work that's not as
high-pressured. â€œI'm burnt out,â€? she says. â€œI
can't stand it. There are too many patients and not enough
support.â€?

Demographic trends, cultural shifts and image problems are
eroding the ranks of the nursing profession. Despite a slight
post-Sept. 11 rise, enrollment in nursing programs has been
declining at an average rate of 4.2 percent a year since 1993, when
it peaked at 270,000. As of 2000, enrollments were down 33 percent,
to 181,000, according to the National League for Nursing. If the
trend continues, nursing will face more staff vacancies by 2010
than any other professional category, according to projections from
the Bureau of Labor Statistics (BLS). The agency pegs the number at
a staggering 1 million job openings due to more demand and net
replacement needs between 2000 and 2010. The dwindling interest in
nursing comes at a critical juncture: A chunk of the country's 78
million Baby Boomers are poised to retire by 2010 â€” creating
a surge in demand for the health-care services associated with an
older population at the very time that there will be fewer nurses
in the work force. â€œWe've got a real problem ahead,â€?
says Peter Buerhaus, professor of nursing and senior associate dean
for research at Vanderbilt University. â€œThe magnitude of
these shortages would be big enough to severely hamper health
care.â€?

Formerly prized as one of only a handful of professions open to
women, nursing has fallen out of favor with a new generation.
Thanks to a wider range of career opportunities, young girls today
seldom dream of growing up to be Florence Nightingale. According to
the BLS, the median age in nursing in 2001 was 43, compared with 39
in 1989, the earliest age data available for RNs. The share of
working RNs under age 35 dropped to 24 percent in 2001, from 37
percent in 1989, reports the BLS. The share of young registered
nurses under age 25 sank to 3 percent in 2001, from 5 percent in
1989. Says Angela McBride, dean of Indiana University's School of
Nursing: â€œWomen used to become a grammar school teacher, a
nurse or a nun.â€? The women's movement helped expand the range
of career options open to women; at the same time, the jobs women
historically gravitated to were spurned in favor of the more
lucrative, formerly male-dominated professions.

Forget attracting new candidates, nursing is having trouble
holding on to its own due to irregular hours, heavy patient loads
and stressful working conditions. A 2001 American Nurses
Association study found that nearly 55 percent of the 7,300 nurses
surveyed would not recommend the profession to others. Another 23
percent said they would actively discourage someone close to them
from entering the field. In addition, nurses display among the
lowest â€œengagementâ€? levels of any category of workers,
according to the Gallup Organization. Nearly 24 percent of the
22,000 nurses surveyed between 1999 and 2001 say they are
â€œdisengagedâ€? from their work, defined as physically
present but psychologically absent, compared with 16 percent of
workers nationally who feel the same.

The number of those exiting the field is rising: The 135,696 RNs
who were employed in non-nursing occupations in March 2000
represented a 15 percent increase over the 117,820 such nurses in
1996 and a 36 percent increase over the estimated 99,955 in 1992,
according to the National Sample Survey of Nurses, conducted by the
Health Resources and Services Administration. The exodus is likely
to continue. One of every five nurses plans to leave the profession
within the next five years, according to a survey of 700 current
direct-care nurses and 207 former direct-care nurses, conducted for
the Federation of Nurses and Health Professionals in 2001. And half
of current nurses say that within the past two years, they have
considered leaving the patient-care field for reasons other than
retirement. What's more, the number of nursing school grads who sat
for the national licensing exam for registered nurses has declined
29 percent since 1995, figures from the National Council of State
Boards of Nursing reveal.

The No. 1 problem nurses cite is staffing. According to the
Federation of Nurses and Health Professionals' survey, nurses say
they are fed up with working conditions. In addition to working too
many hours and performing thankless tasks, nurses also complain
about conditions that may adversely affect patient care. For
Mosier, the final straw came last March, when she worked as a temp
nurse at an assisted living facility where the ratio of nurses to
patients was an astounding 1 to 84. â€œI never thought it would
be like this,â€? she says.

Then there's Karla Monroe, 46, of Terre Haute, Ind. After 27
years of working nights, weekends and holidays, and being required
to float to other departments (such as obstetrics, where she had no
expertise), Monroe enrolled in a business school program in
February 2001. After she gets her master's degree in management
this year, she hopes to find administrative work at a university.
â€œI like what I do. I'm good at what I do,â€? she says.
â€œBut I don't like how I have to do it anymore.â€?

Currently, hospitals are short an estimated 126,000 nurses,
according to the American Hospital Association. The national
vacancy rate for registered nurses ranged from 14.6 percent in
critical care to 6.5 percent for nurse managers, according to a
survey of 700 nurse executives commissioned in 2000 by the American
Organization of Nurse Executives (AONE). The direct impact of the
staffing shortage is substantial: 51 percent of those surveyed
cited emergency department overcrowding, 69 percent reported higher
costs to deliver care and 25 percent said beds had to be closed,
AONE found.

To address the shortage, some hospitals are employing traveling
nurses, offering sign-on bonuses, overhauling their recruiting
approaches and recruiting out-of-state. The nursing profession may
also benefit from casting a wider net to include a more diverse
pool of workers: Compared with the national work force, which was
47 percent female and 83 percent white in 2000, the registered
nurse population was 93 percent female and 87 percent white,
according to the BLS. Blacks made up only 5 percent of the
registered nurse population in 2000 and Hispanics only 2 percent,
though each group constitutes 11 percent of the national work
force, according to the National Sample Survey. Asians were 4
percent of the working registered nurse population and make up 5
percent of the work force.

It's therefore no surprise that marketing campaigns are underway
to counter nurses' own bad PR about their profession and to
influence the next generation's career choices. Johnson &
Johnson launched a $20 million national television advertising
campaign in February 2002 to stimulate interest in nursing.
â€œBy using images of more male and ethnically diverse nurses
in our marketing materials, we hope to recruit from a broader group
of people than nursing has historically attracted,â€? says John
McKeegan, spokesman for the New Brunswick, N.J.-based health-care
products manufacturer. â€œIf we can lure a more diverse group
of people into nursing, we may well be on our way to addressing the
shortage.â€?

The Johnson & Johnson campaign created recruitment materials
for distribution by school guidance counselors, a Web site that
profiles a range of nursing specialties and scholarships for
nursing students and prospective nursing faculty. A campaign has
also recently been launched by the Nurses for a Healthier Tomorrow,
a not-for-profit coalition of 37 nursing and health care
organizations. The group's $1.5 million campaign of print and TV
public service announcements aims to promote nursing as a career to
Gen X and Gen Y. In May 2002, promos began to run in 436 movie
theaters before such movies as Spiderman and Star
Wars. The ads were expected to reach some 2.5 million people in
13 major markets. â€œIt's a good way to reach young people who
haven't considered nursing before, as well as older career
changers,â€? says Kathy Bennison, the coalition's manager of
marketing.

Suggestions abound for ways to stem the nursing shortage; among
them is the notion that the field may appeal to second-career
seekers as well as to more diverse recruits, especially young men.
Recruitment and retainment policies must appeal to different
generations' particular needs and values, says Will Ruch, CEO and
managing partner of Milwaukee-based marketing/recruitment
consultancy Versant Solutions, which counts the Visiting Nurses
Association among its clients. He says it's important to help
nurses develop their talent, because once they stop learning on the
job, they're apt to look elsewhere. Indeed, because the parents of
Gen X and Gen Y lost jobs during recessions, these generations may
be less likely to be loyal to companies and more interested in
learning what they can get out of a job, says Bruce Tulgan, CEO of
New Haven, Conn.-based RainmakerThinking, a workplace research and
management training firm. He recommends recruiters make a point of
framing messages in terms of what the workplace has to offer new
hires.

Meanwhile, Susan Mitchell, author of American Generations
(New Strategist Publications, 2000), suggests employers play up the
job security in nursing. The stability of the profession would
appeal to Gen X, she says, due to its experience with a rocky
economy.

A benefit that few realize the profession has to offer is
competitive salaries, says Dani Eveloff, recruitment coordinator
for the University of Nebraska Medical Center (UNMC) College of
Nursing. Traditionally, nursing has been seen as a
â€œcallingâ€? that many assume doesn't pay, Eveloff says.
However, she adds that compensation varies considerably. While
staff or general duty nurses averaged $42,133 in earnings in 2000,
nurse practitioners averaged $60,534 and certified nurse
anesthetists averaged $93,787. The UNMC's new brochures emphasize
the potential for high salaries, including bonuses, loan repayment
options and career flexibility. They also feature more male and
minority students. The new brochures for UNMC's nursing school
debuted in 2000; a year later, its applicant pool had increased by
29 percent and the number of minority applicants grew by 225
percent.

Health-care experts say it's never too early to start
recruiting. The UNMC College of Nursing plants the seed for a
nursing career by discussing the profession with preschool and
elementary school children. The school has developed a coloring
book that features males and minorities in varied nursing roles.
Children in kindergarten and the first grade are invited to tour
the medical center. For many, it's the first time they encounter
nurses. Says Eveloff: â€œWe start small.â€?

While the forces eroding the ranks of nurses may not be easy to
reverse, there are some small glimmers of hope. A majority of
nursing schools report that applications are up after years of
decline, according to the American Association of Colleges of
Nursing. For example, Georgetown University's School of Nursing saw
applications rise 10 percent over last year. And applications to
Saint Louis University's School of Nursing increased by 53 percent
over 2001, reversing a steady decline that began in the
mid-1990s.

Educators attribute the swell in applications to a shift in
values post-Sept. 11, in which nursing and healing professions in
general gained stature in the public eye. â€œIs this fleeting
or will it last?â€? asks Margie Edel, director of the
baccalaureate and master's programs at Saint Louis. â€œI'm
hopeful.â€?

SLOW TO DIVERSIFY

Registered nurses are far less likely to be black or Hispanic
than the national labor force.

*An index of 100 is the national
average. For example, in 2000, whites (non-Hispanic) are 18 percent
more likely than the average American to be registered nurses.
African Americans are 57 percent less likely than average to be
registered nurses.